The use of assisted reproduction technologies is undoubtedly successful in the treatment of sterility. However it sets up numerous of issues for the obstetricians and neonatologists.
Aims: To evaluate the incidence, the specific problems and the neonatal outcome of newborns with very low birth weight (VLBW) <1500 g born from pregnancies after in vitro fertilization (IVF).
Methods: The study enrolled all 563 VLBW infants admitted in the NICU of the "Maichin Dom" hospital from 01.01.2008 to 30.06.2010. 119 (21.1%) of them were conceived with assisted reproduction technology (IVF- group), and 444 (78.9%) were conceived naturally (control group). All infants were followed up till their discharge home or death. Poor outcome measures were in hospital neonatal death or morbidities with long term sequels: severe congenital malformations, bronchopulmonary dysplasia, severe brain injuries (intraventricular haemorrhages gr. Ill-IV periventricular leucomalacia), retinopathy of prematurity gr. Ill-V.
Results: There were no significant differences in terms of mean birth weight (BW) and gestational age (GA) between the groups (1170 g and 1173 g, 29,8 and 30,0 weeks of gestation respectively). Intrauterine growth retardation (BW of <10 percentile for GA) was observed in 42% in the IVF-group, versus 38.5% (NS) The frequency of the babies from multiple pregnancies was significantly higher in the IVF-group: 88.2% versus 27.5%, and the triplets were 48% versus only 0.9% in the control group. In the IVF-babies more active obstetric approach was carried out: caesarean section in 85% versus 57%, and completed antenatal corticosteroid course in 80% versus 41% in the control group. There were no significant differences of in hospital neonatal mortality rate - 14.3% in the IVF-group versus 14.9%; congenital malformations or severe morbidities at discharge - 22.7% versus 27.5%, discharged in good health - 63% versus 57.6%.
Conclusions: The major problems of VLBW-newborns after IVF result from the higher incidence of multiple pregnancies with their corresponding risks. Nevertheless, strict pregnancy follow-up, more frequently use of antenatal steroids, cesarean delivery such as intensive neonatal resuscitation ensure a clinical outcome and prognosis which do not differ from the naturally conceived VLBW-newborns.